This study was designed to test whether there were differences in dietary Ca intake, plasma FGF23 concentrations and urinary phosphate excretion between RFU and LC children and to identify other potential contributing pathologies to the aetiology of rickets, such as a perturbed vitamin D metabolism, OSI-744 concentration impaired renal tubular function and poor liver function. Written informed consent was obtained from parents of the children involved in the study. Ethical approval was given by The Gambian Government/MRC Laboratories Joint Ethics Committee. The 46 children

in the original case-series were those who had attended clinics in MRC Fajara or MRC Keneba, The Gambia, between July 1999 and March 2002 with a presentation of leg deformities consistent with rickets [2]. Most were from the West Kiang province. Attempts were made to trace all these children for recruitment check details into the follow-up study. 35 children (12 female, 23 male, median (IQR) age 8.5 (2.6 years) were available and were included in RFU.

The mean (SD) time interval between presentation and follow-up was 5.3 (0.5) years (range 4.2–6.0 years). All measurements on these children were made during May to September 2006. Age- and season-matched data were obtained from a community study which provided anthropometry, biochemistry, and dietary measurements from 30 Gambian children (LC children). This study was conducted during September and October 2007. The LC children were selected from mafosfamide the West Kiang Demographic Survey Database and were divided into three age bands ranging from 6 to 18 years, with the aim of recruiting a representative

sample of 5 girls and 5 boys in each age band. West Kiang was divided into 5 geographical areas and 1 male child and 1 female child were randomly selected from each of the areas in the age bands 6.0–9.9 years (AG1), 10.0–13.9 years (AG2), and 14.0–17.9 (AG3) years. Exclusion criteria included the current use of medication affecting bone mineral metabolism, intestinal, hepatic or renal function, and reported illness in the week preceding the study. A health check was carried out on RFU and LC children, paying particular attention to complaints or signs relating to bone, renal, intestinal and hepatic health. In addition for RFU children, a more detailed clinical assessment was conducted to identify the presence of any clinical signs and symptoms of rickets including seizures, frontal bossing, enlarged costochondral junctions, enlarged wrists or ankles, leg pain, difficulty walking and knock-knee, bow-leg or windswept deformity. Anteroposterior radiographs and medical photographs were taken of both knees and both wrists of RFU children. Radiographs were scored by a consultant paediatrician (JMP) using a 10-point scoring system developed by Thacher et al. [5].